Orthopedic Surgery--Major Changes in Hospital Care and Payment
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- Опубликовано: 12 авг 2022
- The Gist Newsletter and Stratasan have created an excellent analysis of the shift in knee replacements and hip replacements from the hospital inpatient setting to outpatient and ASCs.
Inpatient Total Knee Replacements have decreased from 100% to 25% between 2017 and today.
Inpatient Total Hip Replacements Have decreased from 100% to 37% from 2017 and today.
Meanwhile, Outpatient and ASC Total Knee and Total Hip Replacements have gone from 0% in 2017 to the VAST MAJORITY today.
Why? Why do so many fewer inpatient orthopedic surgeries happen?
1. CMS removed Knee Replacements from its Inpatient Only List in 2018. Prior to 2018, Medicare would only pay if the surgery was done in the inpatient setting.
Likewise, CMS removed Total Hip Replacements from its Inpatient Only List in 2019.
2. COVID--The Pandemic caused many hospitals to cancel their operating room schedules because of infection and staffing problems and as a result, orthopedic surgeons moved their surgeries to ASCs where the risk of cancelations is lower.
What are the Implications?
1. Employers win because ASCs generally have lower facility fees than hospitals, so their joint replacement unit costs will be lower.
2. Hospitals lose because lucrative commercially insured patients are now having their joint replacement surgeries outside of their hospital system.
3. For-profit hospital system Tenet is transitioning from being a 'hospital company' to being an ASC company and now runs 310 ASCs nationwide... more than any other organization. Tenet's ASC revenue went from 5% of its total revenue in 2015 to 42% of its total revenue in 2021--an almost 9X increase!
As this orthopedic example illustrates, change can be rapid in healthcare when the PAYMENT Changes.
Sources:
mailchi.mp/11f2d4aad100/the-w...
info.stratasan.com/gist
www.chartis.com/insights/medi...
www.healthcaredive.com/news/t...
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Dr Bricker, your fund of knowledge is boundless. As an arthroplasty leader having navigated our hospital based COE through this evolution, I can confirm not only your data but your conclusions. Perhaps do a sequel on what it takes to move this mass of patients from IP to ASC in just a matter of years, safely and effectively, without compromising clinical outcomes - not an easy feat. We should also recognize that many of these ASCs are privately held by smart entrepreneurial orthopedic practices and the strong economic incentive of new facility fee revenue streams is omnipresent. Thank you!
Thank you for watching and sharing your perspective.
Awesome video! A current MHA candidate and had a case study competition about this! Explained really well!
Thank you for your feedback.
Your content is gold. As a primary care doc, I am learning so much about health care economics.
Thank you for your feedback.
These AHealthcareZ videos are simply amazing. Thank you so much Doctor.
Thank you for watching and for your kind feedback.
Always...follow the money 💰
Great update 👍
Thank you for watching and for your feedback.
@@ahealthcarez will be interesting to see how bundled payments in the value-based model will articulate with the shift.
"where you stand depends upon where you sit" gold
No my expression… but very #True. Thank you for watching.
Very informative as always Dr. Bricker. How about following up this message with one about the efficacy of Regenerative Treatments for Hip and Knee and Spine problems using non-surgical Mesenchymal Stem Cells (MSCs) grown from the stem cells found in Wharton's jelly connective tissue from non-stressed (C-Section) umbilical cords. Professional athletes have been using non-surgical regenerative medicine instead of the stress of a surgical mechanism to keep them active and functional. I would love to hear your thoughts on this topic of MSCs.
Thank you for watching and sharing your thoughts.
Great video as always Eric!!! Very informative that traditional medicare doesn't have P/A and medicare advantage does - that incentive alone may keep Medicare alive. I think payments for EVERYTHING will be shifted away from the hospital and hospitals will be reserved for the most complicated cases - don't you think ??
Thank you for your feedback.
As an Internal Medicine doctor, I can tell you there are a ton of non-complicated medical admissions. But I can see your point for surgery.
Very interesting thanks for sharing. this rapid shift are clearly going to drive more demand to ASC’s in the years to come; but in certain states I suspect that the shift will be much less dramatic due to tight restrictions on Certificate of Need.
Thank you for watching and sharing your thoughts.
Amazing 👏. Love all your informative videos. Keep recording 'em.
I've been watching your videos for my master's program...😁
Super! That’s what they are for. Students leave similar messages all the time.
Hi Dr. Eric. Thanks for the awesome and highly informative videos. All of these videos are a great source of knowlege about the US Healthcare system. Whenever you have time, kindly make a short video on the current medical trends post COVID, like the one titled 'Where does Medical Trend Come From?', which was uploaded in 2020. It was a great 6 minute video summerizing how the industry functions. Have a great day, Dr. Eric.
Thank you for watching and for your suggestion.
Thanks Dr. Bricker, i learn so much from your videos, thanks for making these videos. So my question is that do you think the trend of moving surguries to ASC will continue even though CMS paused the elimination of the inpatient only list ? I know they intialy said they get rid of it by 2024 and that's why you still have the point in your video but they back down on it!
Yes. Thank you for watching and for your question.
Very Interesting
So commercial employer insurance are doing way more of these procedures especially if they are doing it in those places that are cheaper than hospitals
While people on Medicare are getting less ( they might need it as much)
Is Medicare still only covering 15000 while the procedure costs 60 to 70?
Is the rest of it or let me rephrase this, how much out of pocket is costing those on Medicare
If inpatient on Traditional Medicare, then just Medicare deductible which is $1,556. Many people have Medicare Supplement Insurance that pays for the deductible.
@@ahealthcarez thank you
Hi Doctor, another great video, thank you so much, my question is that : why CMS's action has impact on the commercially insured patients who are now seeking surgeries outside of their hospital system? because Isn't it CMS only impact medicare, medicaid, etc, but not commercial insurance? If that's the case, commercial patient should go to ASC anyways just as they used to, nothing change for them, and those who were covered under CMS would seeking surgeries outside of their hospital system. Then what do you mean by that outflow of commercial patients to ASC? Sorry if its a stupid question. thank you so much for your patience.
Another question is that I understand ASC has a cheaper facility fee, and that will save money for the insurer, how does that benefit the employer, because aren't the employers still pay whatever they need to commercial insurance ? Same, sorry if that's a stupid question, just really hope to understand that.
Great questions. Couple reasons… 1. Many commercial insurance plans mirror CMS policy. 2. If orthopedic surgeon can schedule Medicare patients at ASC then more likely to schedule commercial insurance patients there too for purely logistical reasons… saves time since they are already there. Don’t need to travel back and forth.
Thank you for watching.
Over half of employees in America are on self-funded plans, which means the employer takes the risk… not the insurance company.
For self-funded employers, the insurance company is paid a fixed fee for their network and to process claims.
Hope that helps.
@@ahealthcarez thank you so much, then its interesting because Why would commercial insurance plans and employer sponsored plans don't direct patient to ASC at the begining, given that its cheaper no matter what the CMS policy is? The 100% in-patient before the CMS new policy is hard to understand from employer self funded plans financial perspective. its easier to understand ASC number goes up after the policy ( doctor logistical reasons) but difficult to understand why from completely O ASC to 33% because of the employer sponsored commercial plans. :) sorry to challenge you but just hope to understand. No need to reply if you are busy. thanks
What do thing if they change the rule for cardiac catheterization?
Not sure. Sorry I can’t be more help.
Thank you for watching.